Hear where the denials team is focused so they can move the needle on insurer A/R.
What are some trends you’re seeing with denials management?
Barb Townsend: “I think it's really interesting the shifts we've seen in denial management in the past few years. We have focused on clinical denials for a long time. And I think we sort of have a handle on clinical denials and what has to happen. But we are still working on that constantly.
“The other part that we’re focusing heavily on is our payer information education, ‘the payer rules.’ How are they reimbursing claims? I have billing and A/R staff that say they don't understand the rules. They don't understand the denials they're getting. And unfortunately, that also translates to the payers (not being able to explain the rules). You know, everybody talks about automation. But the payers have automated to such a point that when you call in to find out about a denial, they don't know why it was denied. All they know is that their system denied it. They don't know their own rules. They don't understand line-item denials and the very granular level of detail behind those denials. So we have to make our team smarter than them. We have to know exactly what we're fighting, especially on high-volume, low-dollar denials.”
